Gynecological and menstrual disorders in women with vasovagal syncope

Muppa, Prasuna; Sheldon, Robert S.; McRae, Maureen; Keller, Nancy R.; Ritchie, Debbie; Krahn, Andrew D.; Morillo, Carlos A.; Kús, Teresa; Talajic, Mario; Raj, Satish R.

doi:10.1007/s10286-013-0190-1

Cited by 12 publications

(9 citation statements)

References 16 publications

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“…Indeed, presyncopal symptoms are more frequent during the menses phase of the menstrual cycle (Muppa et al. ). Menses usually last from day 0 to 5.…”

Section: Discussionmentioning

confidence: 99%

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Dynamic cerebral autoregulation is attenuated in young fit women

et al. 2019

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Young women exhibit higher prevalence of orthostatic hypotension with presyncopal symptoms compared to men. These symptoms could be influenced by an attenuated ability of the cerebrovasculature to respond to rapid blood pressure (BP) changes [dynamic cerebral autoregulation (dCA)]. The influence of sex on dCA remains unclear. dCA in 11 fit women (25 ± 2 years) and 11 age‐matched men (24 ± 1 years) was compared using a multimodal approach including a sit‐to‐stand (STS) and forced BP oscillations (repeated squat‐stand performed at 0.05 and 0.10 Hz). Prevalence of initial orthostatic hypotension (IOH; decrease in systolic ≥ 40 mmHg and/or diastolic BP ≥ 20 mmHg) during the first 15 sec of STS was determined as a functional outcome. In women, the decrease in mean middle cerebral artery blood velocity (MCAvmean) following the STS was greater (−20 ± 8 vs. −11 ± 7 cm sec−1; P = 0.018) and the onset of the regulatory change (time lapse between the beginning of the STS and the increase in the conductance index (MCAvmean/mean arterial pressure) was delayed (P = 0.007). Transfer function analysis gain during 0.05 Hz squat‐stand was ~48% higher in women (6.4 ± 1.3 vs. 3.8 ± 2.3 cm sec−1 mmHg−1; P = 0.017). Prevalence of IOH was comparable between groups (women: 4/9 vs. men: 5/9, P = 0.637). These results indicate the cerebrovasculature of fit women has an attenuated ability to react to rapid changes in BP in the face of preserved orthostasis, which could be related to higher resting cerebral blood flow allowing women to better face transient hypotension.

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“…Indeed, presyncopal symptoms are more frequent during the menses phase of the menstrual cycle (Muppa et al. ). Menses usually last from day 0 to 5.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, we cannot rule out the possibility that dCA changes reported in this study could be amplified and ultimately affect the incidence of IOH later in the menstrual cycle. Indeed, presyncopal symptoms are more frequent during the menses phase of the menstrual cycle (Muppa et al 2013). Menses usually last from day 0 to 5.…”

Section: Limitationsmentioning

confidence: 99%

Dynamic cerebral autoregulation is attenuated in young fit women

et al. 2019

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“…Indeed, women have a greater increase in heart rate (HR) and a greater reduction of stroke volume (SV) during standing than age-matched men (17). Furthermore, a greater incidence of lightheadedness has been observed during menses (i.e., the early follicular phase of the menstrual cycle, when estrogen or progesterone levels are very low) than in the late follicular (high-estrogen) and luteal (high-estrogen and high-progesterone) phases in healthy women and in those with vasovagal syncope (35) or postural orthostatic tachycardia syndrome (38). Lower sympathetic nerve activity in the early follicular than luteal phase during orthostatic stress could be a contributing factor (19).…”

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confidence: 99%

Influence of sex, menstrual cycle, and oral contraceptives on cerebrovascular resistance and cardiorespiratory function during Valsalva or standing

Abidi

Nili

Serna

et al. 2017

Journal of Applied Physiology

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Women experience orthostatic intolerance more than men, and they experience faintness more in the early follicular [i.e., low-hormone (LH)] than luteal [i.e., high-hormone (HH)] phase of the menstrual cycle. Men ( = 13, 25.8 ± 1.8 yr old) and women in the LH (; placebo) and HH (; high dose) phases of the menstrual cycle with (OC; = 14, 22.0 ± 0.8 yr old) or without (NOC; = 12, 21.8 ± 0.5 yr old) oral contraceptive (OC) use underwent the Valsalva maneuver and a supine-sit-stand protocol. Blood pressure, normalized stroke volume [stroke volume index (SVi)], cardiac output index, heart rate, end-tidal CO, and middle cerebral artery (MCA) blood flow velocity were measured. When subjected to the Valsalva maneuver, all women had a greater increase in diastolic and mean MCA blood flow velocity than men ( ≤ 0.065), with no significant effect of menstrual cycle phase or OC use. When subjected to the supine-sit-stand protocol, men had lower MCA blood flow velocity ( < 0.038) than all women, and SVi was higher in men than in the NOC group in all postures ( < 0.011) and in the OC group in the LH phase of the menstrual cycle during standing ( = 0.010). Only men experienced higher resistance index ( < 0.001) and pulsatility index ( < 0.001) with standing. The OC group had lower end-tidal CO ( = 0.002) than the NOC group ( = 0.030) and men ( ≤ 0.067). SVi ( = 0.004) and cardiac output index ( = 0.008) were higher in the OC than NOC group. A tendency toward a lower mean MCA blood flow velocity ( = 0.058) and higher SVi ( = 0.059) and pulsatility index ( = 0.058) was noted in the HH than LH phase. Mean arterial pressure was higher in the OC than NOC group in the LH phase ( = 0.049) and lower in the HH than LH phase ( = 0.014). Our results indicate that cycling estrogens/progestins can influence ventilatory, cardiovascular, and/or cerebrovascular physiology. We have found sex differences in the cerebrovascular response to the Valsalva maneuver and standing. Men have greater cerebral vasoconstriction (or women have greater cerebral vasodilation) during late phase II of the Valsalva maneuver, and the cerebrovascular resistance index increases in men, but not in women, during standing. Furthermore, our findings indicate that both the menstrual cycle phase and oral contraceptive use can influence cardiovascular function both at rest and during active standing.

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“…In addition, we cannot rule out the possibility that dCA changes reported in the current study could be amplified and ultimately affect orthostatic tolerance later in the menstrual cycle. Indeed, pre-syncopal symptoms are more frequent during the menses phase of the menstrual cycle (22). Menses usually last from days 0 to 5.…”

Section: Discussionmentioning

confidence: 99%

Functional implications of impaired dynamic cerebral autoregulation in young healthy women; a comparative investigation

Labreque

Rahimaly

Imhoff

et al. 2018

Preprint

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Women exhibit higher prevalence of orthostatic hypotension with presyncopal symptoms compared to men. These symptoms could be influenced by an attenuated ability of the cerebrovasculature to respond to rapid changes in blood pressure (BP) [dynamic cerebral autoregulation (dCA)]. However, the influence of sex on dCA remains equivocal. We compared dCA in 11 women (25 ± 2 y) and 11 age-matched men (24 ± 1 y) using a multimodal approach including a sit-to-stand maneuver and forced oscillations (5 min of squat-stand performed at 0.05 and 0.10 Hz). The prevalence of initial orthostatic hypotension (IOH; decrease in systolic ≥ 40 mmHg and/or diastolic BP ≥ 20 mmHg) during the first 15 sec of sit-to-stand was determined as a functional outcome. In women, the decrease in mean middle cerebral artery blood velocity (MCAvmean) following the sit-to-stand was greater (−20 ± 8 vs. -11 ± 7 cm sec-1; p=0.018) and the onset of the regulatory change (time lapse between the beginning of the sit-to-stand and the increase in the conductance index (MCAvmean/mean arterial pressure(MAP)) was delayed (p=0.007). Transfer function analysis gain during 0.05 Hz squat-stand was ∼48% higher in women (6.4 ± 1.3 vs. 3.8 ± 2.3 sec; p=0.017). The prevalence of IOH was comparable between groups (4/9 vs. 5/9, p=0.637). These results indicate the cerebrovasculature of healthy women has an attenuated ability to react to large and rapid changes in BP in the face of preserved orthostasis, which could be related to a higher cerebrovascular reserve to face a rapid transient hypotension.NEWS & NOTEWORTHYThe novel findings of this study are that healthy women have impaired dynamic cerebral autoregulation, although the prevalence of orthostatic intolerance was similar in women and men. These results indicate the cerebrovasculature of healthy women has an attenuated ability to react to large and rapid changes in blood pressure in the face of preserved orthostasis, which could be related to a higher cerebrovascular reserve to face a rapid transient hypotension.

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Gynecological and menstrual disorders in women with vasovagal syncope

Cited by 12 publications

References 16 publications

Dynamic cerebral autoregulation is attenuated in young fit women

Dynamic cerebral autoregulation is attenuated in young fit women

Influence of sex, menstrual cycle, and oral contraceptives on cerebrovascular resistance and cardiorespiratory function during Valsalva or standing

Functional implications of impaired dynamic cerebral autoregulation in young healthy women; a comparative investigation

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